The Spectrum of Anterior Cruciate Ligament Reconstruction Options for the Pediatric and Adolescent Patient: A Narrative Review

Cinque, Mark E.; LaPrade, Christopher M.; Rohde, Matthew; Ganley, Theodore J.; Shea, Kevin G.

doi:10.4085/1062-6050-0542.21

Cited by 5 publications

(3 citation statements)

References 78 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The mean Lysholm scores ranged from 80 to 99, which indicated a very good functional outcome [78]. ACL reconstruction in skeletally immature patients aims to restore knee stability, preventing further soft tissue injuries and preserving physiological growth of the lower limb, restoring the pre-injury activity level [79,80]. On the other hand, given their proximity, the risk of growth disturbance from physeal damage with subsequent limb length discrepancy and/or angular deformity should be considered [81,82].…”

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

Migliorini,

Cocconi,

Schäfer

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

PurposeThe present study evaluated the outcomes of anterior cruciate ligament (ACL) reconstruction in children with open physes. The outcomes of interest were to compare the increase in joint laxity and PROMs from baseline to the last follow‐up, the rate and features of the return to sport and the rate of complications.MethodsThis study was conducted according to the 2020 PRISMA guidelines. In October 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles which clearly stated that surgeries were conducted in children with open physis were eligible.ResultsData from 53 studies (1691 procedures) were collected. 35% (597 out of 1691 patients) were women. The mean length of the follow‐up was 44.7 ± 31.3 months. The mean age of the patients was 12.7 ± 1.1 years old. All PROMs significantly improved from the baseline values to those at the last follow‐up. The mean time to return to sport was 8.3 ± 1.9 months. 89% (690 out of 771 patients) returned to sports, 15% (109 out of 721 patients) reduced their level of sports activity or league, and 84% (651 out of 771 patients) returned to their previous level of sport. 9% (112 out of 1213) of patients experienced re‐tear of the reconstructed ACL, and 11% (75 out of 660) of patients underwent a further ACL reoperation. No patients (0 out of 83) demonstrated increased laxity at the last follow‐up, and persistent sensation of instability was reported by 5% (11 out of 235) of patients.ConclusionACL reconstruction in skeletally immature patients is effective and safe, and is associated with fast recovery and a high rate of return to sport.Level of EvidenceLevel IV.

show abstract

Section: Discussionmentioning

confidence: 99%

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

Migliorini,

Cocconi,

Schäfer

et al. 2024

Knee surg. sports traumatol. arthrosc.

View full text Add to dashboard Cite

show abstract

“…In the past years, the debate on the appropriate management after ACL rupture in skeletally immature patients has become heated [ 108 ]. The main concern regarding the trans-epiphyseal technique was the possible damage to the growth plates [ 109 ]. Three different growth disturbances were described [ 110 ], namely, the complete arrest of the growth process, depending on the size of the growth plate injury; overgrowth, caused by hypervascularization after the injury; and impaired growth, caused by the tenoepiphysiodesis effect [ 111 ].…”

Section: Discussionmentioning

confidence: 99%

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Migliorini,

Pilone,

Memminger

et al. 2024

J Orthop Traumatol

View full text Add to dashboard Cite

Background Anterior cruciate ligament (ACL) tears in skeletally immature patients are increasingly common. Evidence comparing the outcomes of all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients is limited, and the current literature could benefit from a comprehensive systematic review. The present study compared all-epiphyseal versus trans-epiphyseal ACL reconstruction in skeletally immature patients. The outcomes of interest were to compare joint laxity, patient-reported outcome measures (PROMs), return to sport, and complications. Methods This study was conducted according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. In November 2023, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. No additional filters were used in the database search. All the clinical studies investigating ACL reconstruction in skeletally immature patients were accessed. Only articles that clearly stated the surgical technique (all- or trans-epiphyseal) were eligible. Only articles with a minimum of 6 months of follow-up were included. Only articles that clearly stated that surgeries were conducted in children with open physis were eligible. Results Data from 1489 patients (1493 procedures) were collected, of which 32% (490 of 1489 patients) were female. The mean length of follow-up was 46.6 months. The mean age of the patients was 12.7 years. No difference was found in joint laxity (Table 3): positive pivot shift (P = 0.4), positive Lachman test (P = 0.3), and mean arthrometer laxity (P = 0.1). No difference was found in PROMs (Table 4): International Knee Documentation Committee (IKDC) (P = 0.3), Lysholm (P = 0.4), and Tegner (P = 0.7). The trans-epiphyseal technique was associated with a greater rate of patients unable to return to sports (1% versus 7%, P = 0.0001) and with a longer time to return to sports (7.7 versus 8.6 months, P = 0.01). Though the trans-epiphyseal technique was associated with a lower rate of return to sport, this difference was not statistically significant (P = 0.8). No difference was evidenced in the rate of patients who had reduced their league or level of sports activity (P = 0.6) or in the rate of patients who had returned to their previous league or level of sports activity (P = 0.7). No difference was found in the rate of complication: re-tear (P = 0.8), reoperation (P = 0.7), increased laxity (P = 0.9), and persistent instability sensation (P = 0.3). Conclusion Trans-epiphyseal ACL reconstruction was associated with a greater rate of patients unable to return to sport and with a longer time to return to sport compared with the all-epiphyseal technique in skeletally immature patients. Level of evidence Level III, systematic review.

show abstract

“…Associated injuries, meniscus and cartilage, should also be considered as a poor outcome, particularly in order of the of the knee functionality. Some years ago, the initial approach to ACL rupture in skeletally immature patients was conservative, [9] but early reconstruction is now considered good practice in most young patients [10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

Anterior Cruciate Ligament Reconstruction Under 18 Years-Old: Functional Level and Sports Activity

MARQUES,

Figueiredo,

BRANCO

et al. 2024

ijirms

View full text Add to dashboard Cite

Introduction: Reconstruction of the anterior cruciate ligament (ACL) in patients under 18 years-old has grown in last decades. Knee ligament rehabilitation aims to normalize functionality and promote a safe return to exercise and sports. This study intends to evaluate the functional capacity, the perception of quality of life and the level of activity, between 18 and 72 months after reconstruction of the ACL, in a population under 18 years old. Methods: Cross-sectional observational study that included a sample of young patients submitted to surgical reconstruction of the ACL. Patients underwent a rehabilitation program and were evaluated between 18 and 72 months after reconstruction. Metric tools were the Knee Outcome Survey - Activities of Daily Living Scale (KOS-ADLS), Short Form (SF)-36 (SF-36) and Tegner Activity Scale (TAS). Descriptive and correlation statistics (Pearson's and Spearman's Correlation Coefficients) were used. Results: This sample included 30 participants, 15 males and 15 females with a mean age of 19.4 ± 2.0 years and a mean postoperative time of 43.0 ± 16.8 months. In 20 patients, meniscus and cartilage injuries were identified. They had a pre-injury TAS of 8.0 ± 1.2 and a current TAS of 4.6 ± 2.2. They currently present KOS-ADLS score of 87.6 ± 11.0 and in the SF-36 vitality, mental health, and general health domains respectively 66.3 ± 22.9, 75.9 ± 19.9 and 75.5 ± 20.0. Conclusion: Patients under 18 years old undergoing ACL reconstruction have a high perception of knee functionality and quality of life. However, after the rehabilitation program, they significantly lower the level of sports activity. Meniscus and cartilage injuries negatively may affect functional capacity.

show abstract

The Spectrum of Anterior Cruciate Ligament Reconstruction Options for the Pediatric and Adolescent Patient: A Narrative Review

Cited by 5 publications

References 78 publications

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

Anterior cruciate ligament reconstruction in skeletally immature patients is effective: A systematic review

All-epiphyseal anterior cruciate ligament reconstruction yields superior sports performances than the trans-epiphyseal technique in skeletally immature patients: a systematic review

Anterior Cruciate Ligament Reconstruction Under 18 Years-Old: Functional Level and Sports Activity

Contact Info

Product

Resources

About